Lühnen Julia, Haastert Burkhard, Richter Tanja
Unit of Health Sciences and Education, Faculty of Mathematics, Computer Science and Natural Sciences, Universität Hamburg, Martin-Luther-King-Platz 6, 20146 Hamburg, Germany.
Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Germany.
Geriatrics (Basel). 2024 May 9;9(3):60. doi: 10.3390/geriatrics9030060.
Legal representatives take a major role in healthcare decisions with and for people with dementia, but only a minority has a qualification in this field. The aim was to evaluate the efficacy of the PRODECIDE education program for legal representatives. In a prospective randomized controlled trial, legal representatives (volunteers and professionals, representing at least one person with dementia) were allocated (1:1 computer-generated block randomization) to the intervention (PRODECIDE education program) and control (standard care) groups. The primary outcome measure was knowledge, operationalized as the understanding of decision-making processes and in setting realistic expectations. Only data entry and analyses were blinded. A process evaluation in a mixed methods design was performed. We enrolled 218 legal representatives, and 216 were included in the primary analysis (intervention = 109, control = 107). The percentage of correct answers in the knowledge test post intervention was 69.0% in the intervention and 43.4% in the control group (difference 25.6%; CI 95%, 21.3 to 29.8; < 0.001). In the comparison of professional and voluntary representatives, professionals had 13.6% (CI 95%, 8.0 to 19.2; < 0.001) more correct answers. The PRODECIDE education program can improve the knowledge of legal representatives, an important prerequisite for evidence-based, informed decision-making.
法定代表人在为痴呆症患者做出医疗保健决策以及代表他们做出决策方面发挥着主要作用，但只有少数人具备该领域的资质。本研究旨在评估面向法定代表人的PRODECIDE教育项目的效果。在一项前瞻性随机对照试验中，法定代表人（志愿者和专业人员，代表至少一名痴呆症患者）被分配（1:1计算机生成的区组随机化）到干预组（PRODECIDE教育项目）和对照组（标准护理）。主要结局指标是知识，具体表现为对决策过程的理解以及设定现实的期望。只有数据录入和分析是盲法的。采用混合方法设计进行了过程评估。我们招募了218名法定代表人，216名被纳入主要分析（干预组 = 109名，对照组 = 107名）。干预后知识测试中正确答案的百分比在干预组为69.0%，在对照组为43.4%（差异25.6%；95%CI，21.3至29.8；P<0.001）。在专业代表和志愿代表的比较中，专业人员的正确答案多13.6%（95%CI，8.0至19.2；P<0.001）。PRODECIDE教育项目可以提高法定代表人的知识水平，这是基于证据的明智决策的重要前提。
